Confessions of a sex therapist

SINGAPORE - Occupational and sex therapist Ms Shirlene Toh has a patient to thank for prompting her to set up the Sexual Wellness Service, providing sexuality education to patients with disabilities at the rehabilitation centre.

About a decade ago, a tetraplegic man in his 30s, who had lost all feeling from the neck down because of a road traffic accident, told her he was concerned about how he would "perform" when he returned home.

The 36-year-old recalled: "I summoned up the courage to ask him what he meant specifically and he said he feared his condition would affect his relationship with his wife."

It dawned on Ms Toh that sexuality was an issue of great concern to her patients. With advice from a senior therapist, she gathered information to teach the man about the impact of spinal cord injury on sexuality.

She pursued a master's degree in sexual health at the University of Sydney in Australia in 2005 on a Ministry of Health award. She is now a principal occupational therapist at Tan Tock Seng Hospital's (TTSH) Rehabilitation Centre and  the only trained sex therapist at TTSH.

Ms Toh is married to a 36-year-old engineer. They have two sons, aged seven and four.

I specialise in sexual wellness and education because...

Sex is a part of everyday life that is more often neglected than, say, bathing, dressing and walking. Very often, patients' sexual concerns are not addressed adequately or patients do not know whom to seek help from.

They are often fearful of seeking help from health-care professionals, so they resort to trying things on their own and putting themselves and their partners at risk of injury.

One little known fact about being a sex therapist is...

We are taught how to address sexual issues a person may encounter throughout life. These include the development of sexuality, masturbation, fantasy, sexual abuse, sexually transmitted illnesses, cybersex, gay and lesbian relationships and so on.

The aim is to expand our awareness and understanding of the most relevant sexual issues in today's society.

I have to be non-judgmental. Even though I am against pre-marital sex, I still advise patients who want to engage in it to practise safe sex.

If I were to give an analogy for what I do, I would...

Be a Cupid who is a catalyst in helping others rekindle their love for each other.

I encourage my patients and their partners to keep open lines of communication and share their thoughts and feelings.

A typical day for me...

Has me waking up at 6.30am to be in the office by 7.30am. I have dual roles of an occupational therapist and sex therapist.

When patients' partners come along for the sexuality session, I may spend up to an hour counselling them. In total, I see four to six patients a day.

When I see a patient for the first time, I explain to him my role as a sex therapist and start with an education session about how the disability - whether from stroke or a spinal cord or brain injury - may affect his sexual expression.

Men with spinal cord injuries may have difficulty achieving erection or ejaculation, while women may lack lubrication or be psychologically fearful of engaging in sex.

I will then ask the patient about his sexual experience and address common misconceptions of sexuality and disability, such as thinking that people with disabilities are no longer sexual beings.

I have come across all types of cases...

From simple cases that involve teaching a man or his partner how to put on a condom to more complex cases which involve the use of devices to create erections.

I love patients who are...

Keen to work on building satisfying relationships. Both parties accept that they have problems in their relationships and are receptive to counselling. They will usually have common goals and are willing to explore different strategies.

Patients who get my goat are...

Those who insist that communication is unimportant in a relationship.

Some men insist that it is the duty of the wife to "serve" the husband and neglect building trust and making each other feel loved.

Patients may hold values that are difficult to change, which makes it challenging to change their mindsets and hence their behaviour.

Things that put a smile on my face are...

Patients continuing to have fulfilling relationships post-injury. Some tell me the current states of their relationships surpass that of when they were dating or on their honeymoon. They appreciate the advice I give and are able to work with their partners to reach a common objective.

It breaks my heart when...

Patients with sexual concerns are left struggling on their own, leading them to try unsafe sexual methods and feeling depressed.

They may also suffer in silence and slowly withdraw from society because they are fearful of meeting people. They may eventually be unable to form significant relationships with others.

I would not trade places for the world because...

I feel that everyone has a right to love and be loved. The inability to access correct information and the lack of education are stumbling blocks to achieving rewarding and fulfilling relationships.

My best tip is...

Health-care professionals should understand their own sexual attitudes, beliefs and values, after which they need to decide if they are comfortable addressing patients' sexual concerns.

If these concerns are raised and their body language shows they are awkward discussing them, patients pick this up as something negative. This, in turn, will deter them from seeking professional help.

Those who are uncomfortable discussing sexuality with their patients should refer them to others who are comfortable doing so.

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